Always so many variables in these situations with older babies.  She could try staying in "preventative maintenance" mode on the plugged ducts.  Mothers get tired of messing with their breasts while trying to resolve a plugged duct, and tend to stop the home-care measures as soon as the lump is gone.  Tired, busy mothers don't tend to notice a new plug until it is substantial.

So suggest remaining on the look-out and keeping the circulation high and the breast loosened up --- making sure the bra is not constrictive in any way -- every morning, a warm shower, leaning forward so the breast hangs free, and doing this jiggly "bag of marbles" massage-- working through the tissue, akin to looking for a marble of a particular color in a bag.  And every night a couple minutes of breast massage -- here's a great video -- http://bfmedneo.com/our-services/breast-massage/

If she can pump four ounces after a feeding, it sounds like the supply is still pretty ample.  Sometimes if a mother had an oversupply initially, the baby may have "coasted" in the early months on just catching the milk.  and  now might need some encouragement to actually hold onto a mouthful and milk the breast effectively.  The "fit" between the two of them changes as the baby grows, and sometimes a big baby (and I assume the weight gain has been good?) ends up kind of scrunched, with the chin down on the chest, and it's hard for anyone to eat like that.  So sometimes revisiting the latch, helping the baby get more of a deep "sandwich" of breast, with room to move the jaw.

Is she doing a lot of pumping?  Could that be keeping the supply ramped up, which could cause a back-up on the days when life with two children doesn't let her get the pumping in.  Is she breastfeeding before the solids, as is generally recommended in the first year.  

Anyway, a few thoughts.

Margaret Wills, IBCLC, Maryland, USA
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